Effects of Telephone Counseling Support on Distress, Anxiety, Depression, and Adverse Events in Cancer Patients Receiving Chemotherapy

Oh Nam Ok; Min Sun Nam; Mi Sun Yi; Seon Mi Cho; Eun Ji Kim; Yun Hee Ham; In Gak Kwon

doi:10.5388/aon.2017.17.1.37

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Ok, Nam, Yi, Cho, Kim, Ham, and Kwon: Effects of Telephone Counseling Support on Distress, Anxiety, Depression, and Adverse Events in Cancer Patients Receiving Chemotherapy

Original Article

Asian Oncology Nursing 2017; 17(1): 37-44.

Published online: 31 March 2017

DOI: https://doi.org/10.5388/aon.2017.17.1.37

Effects of Telephone Counseling Support on Distress, Anxiety, Depression, and Adverse Events in Cancer Patients Receiving Chemotherapy

Oh Nam Ok¹, Min Sun Nam¹, Mi Sun Yi¹, Seon Mi Cho¹, Eun Ji Kim¹, Yun Hee Ham¹, In Gak Kwon²

¹Department of Nursing, Samsung Medical Center, Seoul, Korea.

²Department of Nursing, Samsung Medical Center, Seoul Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Korea.

Address reprint requests to: Kwon, In Gak. Samsung Medical Center, 81 Irwon-Ro Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-2904, Fax: +82-2-3410-6616, ingak.kwon@samsung.com

Received 7 December 2016 Revised 25 March 2017 Accepted 26 March 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study is aimed at identifying the effects of telephone counseling as nursing support on distress, anxiety, depression, and adverse events in cancer patients undergoing their first chemotherapy.

Methods

This was a randomized controlled trial (pretest-posttest design). A total of 70 patients who showed 4 or higher distress scores were selected from the screening process. Four patients dropped out; therefore, 66 patients participated in this research. Thirty-two and 34 patients were randomly assigned to the experimental and the control group, respectively. After a preliminary survey, telephone counseling support was given to the experimental group at three time points. The post survey was done before the second cycle of chemotherapy.

Results

Regarding distress, both groups showed a statistically significant decrease in the scores: 3.4 for the experimental group and 1.8 for the control group (p=.002). Furthermore, the experimental group demonstrated a statistically significant decrease relative to the control group. Anxiety and depression showed no statistically significant difference between the two groups.

Conclusion

This study concludes that nursing support through phone counseling is effective in decreasing distress in patients undergoing chemotherapy for the first time.

Keywords: Telephone Counseling Support, Distress, Anxiety, Depression

Figures and Tables

Fig. 1

Research design.

Table 1

Protocol of the Telephone Counseling

Topic	Contents	Technique	Time
1. Introduction	- Greeting and form rapport	- Respect - Acceptance	1 min
2. Assessment	- Check chemotherapy complications - Measure severity of distress, anxiety and depression	- Identify treatment-related side effects - Empathy - Reflective listening	3 min
3. Identification of coping strategies utilized	- Clarify effects of coping - Find barriers - Figure helpers available - Invite new strategies	- Affirmation - Summary of experiences - Clarification of strength and weakness - Search for resources	5 min
4. Offering standard information	- Information on medication, nutrition and daily life 3 days: symptom management 1 week: symptom management & prevention of infection 2 week: symptom management, visit schedule & recheck of pre-examination - Emotional support	- Education - Informational support - Affirmation	7 min
5. Exploration of inquiries	- Answer the questions	- Encouragement	3 min
6. Closing	- Check next visit schedule and time (1week & 2 week) - Finishing greeting - Disconnect	- Openness	1 min (Total 20 min)

Table 2

Homogeneity Test of General, Disease related Characteristics and Dependent Variables between Experimental and Control Group (N=66)

Variables	Categories	Exp. (n=32)	Cont. (n=34)	t	p
Variables	Categories	n (%) or M ± SD	n (%) or M ± SD	t	p
Gender	Male	7 (21.9)	4 (11.8)	1.21	.271
Gender	Female	25 (78.1)	30 (88.2)	1.21	.271
Marital status	Married	25 (78.1)	28 (82.3)	0.19	.666
Marital status	Single/divorced/widowed/separated	7 (21.9)	6 (17.7)	0.19	.666
Education	≤Middle school	4 (12.5)	8 (23.5)	8.81	.012
	High school	6 (18.7)	15 (44.1)
	≥College	22 (68.8)	11 (32.4)
Current employment status	Employed	12 (37.5)	9 (26.5)	0.92	.336
Current employment status	Unemployed	20 (62.5)	25 (73.5)	0.92	.336
Religion	Yes	21 (65.6)	26 (76.5)	0.95	.331
Religion	No	11 (34.4)	8 (23.5)	0.95	.331
Type of cancer site	AGC	5 (15.6)	2 (5.9)	2.84	.625^*
	Breast	18 (56.3)	24 (70.6)
	Colorectal	6 (18.8)	5 (14.7)
	NSCLC	1 (3.1)	2 (5.9)
	Others	2 (6.2)	1 (2.9)
Treatment status	Adjuvant	20 (62.5)	22 (64.7)	4.96	.139^*
	Palliative	2 (6.3)	7 (20.6)
	Neo-adjuvant	9 (28.1)	5 (14.7)
	Definitive	1 (3.1)	0 (0.0)
Regimen	AC/FAC	17 (53.1)	24 (70.6)	4.23	.238
	XELOX	11 (34.5)	7 (20.6)
	Platinum	2 (6.2)	3 (8.8)
	Others	2 (6.2)	0 (0.0)
Age (year)		46.9 ± 11.9	51.5 ± 9.7	1.73	.088
Distress		6.3 ± 1.8	6.1 ± 1.5	−0.61	.541
Anxiety		9.4 ± 4.2	10.8 ± 4.4	1.34	.186
Depression		10.3 ± 4.3	11.4 ± 3.3	1.20	.236

^*Fisher's exact test; AC= Doxorubicin, cyclophosphamide regimen; FAC= Fluorouracil, doxorubicin, cyclophosphamide regimen; XELOX= Capecitabine, oxaliplatin regimen.

Table 3

Comparison of Change in Distress, Anxiety, and Depression between Experimental and Control Group (N=66)

Variables	Groups	Pretest	Posttest	t	p	Difference	F^*	p
Variables	Groups	M ± SD	M ± SD	t	p	M ± SD	F^*	p
Distress	Exp. (n=32)	6.3 ± 1.8	2.9 ± 1.8	9.89	<.001	−3.4 ± 2.0	3.76	.002
Distress	Cont. (n=34)	6.1 ± 1.5	4.3 ± 2.2	5.01	<.001	−1.8 ± 2.1	3.76	.002
Anxiety	Exp. (n=32)	9.4 ± 4.2	5.9 ± 2.7	6.66	<.001	−3.5 ± 3.0	0.11	.678
Anxiety	Cont. (n=34)	10.8 ± 4.4	7.6 ± 4.2	6.78	<.001	−3.2 ± 2.7	0.11	.678
Depression	Exp. (n=32)	10.3 ± 4.3	8.9 ± 4.0	2.12	.042	−1.4 ± 3.7	0.73	.427
Depression	Cont. (n=34)	11.4 ± 3.3	9.3 ± 3.9	3.19	.003	−2.1 ± 3.9	0.73	.427

^*ANCOVA: Pre-test level, education as covariate; Exp.= Experimental group; Cont.= Control group.

Table 4

Comparison of Chemotherapy related Adverse Events (N=66)

Variables	Categories	Exp. (n=32)	Cont. (n=34)	χ²	p^*
Variables	Categories	n (%)	n (%)	χ²	p^*
Nausea	Gr0	2 (6.3)	8 (23.6)	5.96	.089
	Gr1	16 (50.0)	10 (29.4)
	Gr2	14 (43.7)	15 (44.1)
	Gr3	-	1 (2.9)
Vomiting	Gr0	22 (68.8)	28 (82.4)	5.24	.085
	Gr1	10 (31.2)	4 (11.8)
	Gr2	-	1 (2.9)
	Gr3	-	1 (2.9)
Anorexia	Gr0	5 (15.6)	8 (23.6)	1.96	.643
	Gr1	18 (56.3)	15 (44.1)
	Gr2	9 (28.1)	10 (29.4)
	Gr3	-	1 (2.9)
Diarrhea	Gr0	24 (75.0)	26 (76.5)	1.35	.950
	Gr1	6 (18.8)	6 (17.7)
	Gr2	2 (6.2)	1 (2.9)
	Gr3	-	1 (2.9)
Constipation	Gr0	27 (84.4)	23 (67.7)	2.83	.215
	Gr1	4 (12.5)	10 (29.4)
	Gr2	1 (3.1)	1 (2.9)
Oral mucositis	Gr0	20 (62.5)	14 (41.2)	3.95	.237
	Gr1	10 (31.3)	14 (41.2)
	Gr2	2 (6.2)	5 (14.7)
	Gr3	-	1 (2.9)
Neuropathy	Gr0	24 (75.0)	28 (82.3)	3.58	.190
	Gr1	8 (25.0)	4 (11.8)
	Gr2	-	2 (5.9)
Febrile neutropenia	Gr0	29 (90.6)	33 (97.1)	1.20	.348
Febrile neutropenia	Gr3	3 (9.4)	1 (2.9)	1.20	.348
Fatigue	Gr0	6 (18.7)	6 (17.7)	0.96	1.000
	Gr1	26 (81.3)	27 (79.4)
	Gr2	-	1 (2.9)
	Gr3	-	-

^*Fisher's exact test.

Notes

This study was financially supported by the research fund of nursing department of Samsung Medical Center.

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